help needed: cat threw up after shot, what should I do?

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Jenny and Comet (GA)

Member Since 2020
So tonight Comet hit the parameters his vet gave me for insulin: 1/4 unit of Lantus if he was >250 and had eaten a good meal. He was at 279, he ate a good meal, I gave him a shot, and he threw up a few minutes later. What should I do? He's never thrown up after a shot before. He seems okay and is sitting next to me as I type this, but I am quietly freaking out.
 
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Btw, this has happened with Minnie several times. And I got so used to it even when she vomited before the shot, I’d still shoot her because I knew I had 2 hours to give her anti nausea med and get her eating again.

Let us know how it’s going. If he just regurgitated, he should eat again soon without problems
 
With Lantus you have about a 2 hour window till it kicks in. Can you keep trying to feed him as JT suggested? I’d try treats and baby food as well

He took a couple of bites a few minutes ago and threw up again. What happens if the Lantus hits his system and he doesn't have any food down? I have baby food.

Will stress from throwing up make his glucose spike?
 
He took a couple of bites a few minutes ago and threw up again. What happens if the Lantus hits his system and he doesn't have any food down? I have baby food.

Will stress from throwing up make his glucose spike?
Don’t worry about the stress of throwing up. That shouldn’t be a factor. Do you have any antinausea like Cerenia or ondansetron?
 
Don’t worry about the stress of throwing up. That shouldn’t be a factor. Do you have any antinausea like Cerenia or ondansetron?
No, he hasn't needed it before. What happens if he doesn't have any food down by the 2-hour mark? I think he will be willing to eat, he doesn't look bad, I just worry about trying again too soon. But of course don't want to try too late if that will have bad results.
 
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No, he hasn't needed it before. What happens if he doesn't have any food down by the 2-hour mark?I think he will be willing to eat, he doesn't look bad, I just worry about trying again too soon. But of course don't want to try to late if that will have bad results.
It’s hard to say without data on testing. How long since the shot? I’d wait a little to give him a chance to get over it
 
Lantus starts slowly and it’s different for every cat how soon it does start to work, but usually never before 2 hours. Again seeing a spreadsheet with testing data would help answer your question. If you test often and you have +2 data, that should tell you how he reacts to the insulin around the 2 hour mark
 
And I don’t see a spreadsheet link in your signature. Do you have one? It would be helpful to see his bg range with the current dose
It’s hard to say without data on testing. How long since the shot? I’d wait a little to give him a chance to get over it
A bit over an hour since the first time, maybe twenty minutes since the second.

I am sorry I don't have my spreadsheet up yet, we had a period where he wasn't getting any insulin at all and I was using the charts in an app (FreeStyle Libre) there. I can share what I have but it won't be very useful and I can't get it to share because the name is too long and I can't find the sticky that tells you (hopefully) how to give it a shorter name.
 
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A bit over an hour since the first time, maybe twenty minutes since the second.

I am sorry I don't have my spreadsheet up yet, we had a period where he wasn't getting any insulin at all and I was using the charts in an app (FreeStyle Libre) there. I can share what I have but it won't be very useful and I can get it to share because the name is too long and I can't find the sticky that tells you (hopefully) how to give it a shorter name.
Does he have on the freestyle libre sensor, I see it in your signature
 
Probably not I’m just giving you worse case scenario for reference. I’m not sure how the libre works but can you look back at previous days to see how low he goes after +2 and what his nadir had been? That should give you some idea
He actually is only just starting insulin again after an unexpected break of a couple of weeks -- I want to add the values he had during that time but have not had time. I have just posted the spreadsheet, but you will see it doesn't have much info to work with. But from what little there is, it seems like insulin sends him down quickly -- his nadirs were before six hours.
 
How is it looking now? Can you try some baby food?
Sorry for the delay in writing again, he came up and sat on me and purred and demanded scritches for a long time. Just jumped down to have a few more bites of the baby food. Looks like he is at around 280 now at about 2-1/2 hours out. So, close to where he was before the shot. I will continue to watch and worry but am cautiously hoping that these are good signs and will continue.
 
Sorry for the delay in writing again, he came up and sat on me and purred and demanded scritches for a long time. Just jumped down to have a few more bites of the baby food. Looks like he is at around 280 now at about 2-1/2 hours out. So, close to where he was before the shot. I will continue to watch and worry but am cautiously hoping that these are good signs and will continue.
OK that sounds good , glad he had some more baby food. Can you put that 280 in the spreadsheet please , you would put 280 @+2.5
Whenever you can just keep putting his BG on the spreadsheet :cat:
 
Looking at the numbers you have in there now, I wouldn’t be skipping doses. If he’s staying consistently in the 200’s, he needs insulin. The goal is for him to be in blues and greens most of the time.
What would you suggest? The vet told me 1/4 unit if he was at 250 and had eaten; if he is lower than 250, she doesn't want me to shoot. She also thought he could do just one shot a day. I didn't think that was right based on what I have read here and asked her about the importance of twice a day doses on Lantus due to it being a depot insulin and she said, "Well, it's twice a day for some cats, once for others, it really just depends on the cat." Editing to add that he started out at 1 unit and then 1/2 but seemed sensitive to that much, so decreased to 1/4.
 
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What would you suggest? The vet told me 1/4 unit if he was at 250 and had eaten; if he is lower than 250, she doesn't want me to shoot.she also thought he could do just one shot a day. I didn't think that was right based on what I have read here and asked her about the importance of twice a day doses on Lantus due to it being a depot insulin and she said, "Well, it's twice a day for some cats, once for others, it really just depends on the cat."
I am going to tag a few people that might suggest a no shoot number for you.
No way should you give lantus once a day.

@Bron and Sheba (GA)

@Panic

@tiffmaxee

@Deb & Wink

Ladies would you mind taking a look at Jenny's spreadsheet.
She made some notes on it.
Comet has the freestyle libre sensor on.
Please take a look at what's been happening
Thanks so much :bighug:
 
I am going to tag a few people that might suggest a no shoot number for you.
No way should you give lantus once a day.

@Bron and Sheba (GA)

@Panic

@tiffmaxee

@Deb & Wink

Ladies would you mind taking a look at Jenny's spreadsheet.
She made some notes on it.
Comet has the freestyle libre sensor on.
Please take a look at what's been happening
Thanks so much :bighug:
Thank you Diane! Let’s see if we all agree:)
 
What would you suggest? The vet told me 1/4 unit if he was at 250 and had eaten; if he is lower than 250, she doesn't want me to shoot. She also thought he could do just one shot a day. I didn't think that was right based on what I have read here and asked her about the importance of twice a day doses on Lantus due to it being a depot insulin and she said, "Well, it's twice a day for some cats, once for others, it really just depends on the cat." Editing to add that he started out at 1 unit and then 1/2 but seemed sensitive to that much, so decreased to 1/4.
And have you read all the yellow sticky notes on the Lantus forum? In particular, the one about the dosing protocols because it gives you suggested shoot and no shoot ranges. Honestly, I get nervous still under 200 but yesterday I gave Minnie her full dose with an amps of 148 and with the help of folks here she stayed safe all day and in the green range which is what we want. And her numbers are better today because of it. You have to push the comfortable boundary a little to get better results.

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/

Don’t get me wrong, his numbers are not bad but I’d definitely be shooting if he’s over 200. I think 250 is too high a of a no shoot threshold
 
And have you read all the yellow sticky notes on the Lantus forum? In particular, the one about the dosing protocols because it gives you suggested shoot and no shoot ranges. Honestly, I get nervous still under 200 but yesterday I gave Minnie her full dose with an amps of 148 and with the help of folks here she stayed safe all day and in the green range which is what we want. And her numbers are better today because of it. You have to push the comfortable boundary a little to get better results.

https://www.felinediabetes.com/FDMB...-low-go-slow-slgs-tight-regulation-tr.210110/
I have read and wonder how you get the guts to do it. We've had to run to the emergency vet twice due to sudden lows -- they thought he was sensitive to the insulin, so we moved to the 1/4 unit. But he's been on it for such a short time, it's hard to tell what would be right. I am so anxious about everything all the time.
 
Hi. Welcome. You definitely want to shoot every 12 hours. You are using a human Libre, correct? The normal numbers for a cat on a human meter are roughly 50-120. So the numbers on your spreadsheet for what’s considered normal don’t make sense. Was Comet diagnosed in September?
Yes, in September. The vet doesn't want him to go below 70, at least not yet. We had two scares in September.
 
I would definitely go back to twice a day shots. Lantus needs to be given twice a day to be effective and to maintain the depot.
I don’t agree with the vet who says some cats only need once a day dosing with Lantus.

You also need to look and see what dosing method you are going to follow. That will make a difference as when to increase and decrease the dose. So if you could look at two that are at the top of the Lantus page and see what you think. Either SLGS or the TR method.

Comet was actually managing fine in 1/2 unit twice a day But for some reason was swapped to 1/4 unit.
So if you would feel more comfortable with the 1/4 unit, you could start with 1/4 unit twice a day and see how you go.

I would start off with a “take notice” number of 200 and if you get lower than that ...stall, don’t feed and ask for help. Retest in 20 mins to see if it goes up. Then gradually reduce the number you will shoot as you get data.
 
What I am wondering is whether he had a symptomatic hypo or you went to the vet because of a low bg reading. I know when I first saw a 60 nadir I was scared but my vet wasn’t. Max often dropped into the 40’s once regulated but never showed any symptoms of a hypo.
Do you have high carb foods and honey or karro syrup in case you get a reading under 50? If that happens someone here can help you get through it and not need to go to the vet.

if I were you would read the SLFS method and start with that. You will find it on the Lantus forum.
 
Explain the scares please.
The first one was very early on after they had done a curve and told me that's all I needed to know. I came home after running an errand and he was hiding someplace he never goes. I took one look at him, scooped him up, and ran. The vet who took him in at the practice that day confirmed he had gone too low. They kept him overnight to be safe.

The second one is on the spreadsheet. He didn't seem off, but the vet had told me to call if he went below 70, she did not want him to go below that until he was more established in treatment. I called the emergency nurse and kept checking and watched the numbers drop into the low 50s. She told me to feed him honey and a high carb food and I did but his numbers weren't going up, so she told me to get him to the emergency hospital. I did, and they tested him at 84. At the time, I wondered if it was the honey/gravy food kicking in finally. But now when I look at it, I just don't know. Maybe he was still fine. But it looked like he was going to keep going down.

The emergency vet advised the 1/4 unit dose. She said that Lantus seemed to drop him quickly/early and that he might be sensitive to it at the higher doses.
 
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I’d be curious to know how low bg at the first ER visit. I think the second visit was more about yuh enigma cautious and I don’t blame you at all, but if that ever happened again, you’d post and ask for help and someone here would guide you with testing every 30 minutes and feeding to get his numbers safely up. Of course with the libre, to don’t have to do any testing. I assume also he didn’t have the libre a the time of the visits right? That should help you feel a bit safer.

I posted the link to the Lantus dosing protocols above. Check it out but I’m sure you don’t want to do TR, which is more aggressive. SLGS is the one for you.
 
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